As the inventor of a medical device meant to help OBGYNs, I can’t help but get excited when I hear about new technology. This month’s Green Journal features a new visualization system for the Operating Room. Most people who are not OBGYNs don’t spend a lot of time thinking about different surgical approaches. To put it simply, in gynecology, most surgeries have one of four approaches:
1. Abdominal/ Open: A big incision in the belly allows the surgeon to access the area in need of operation.
2. Laparoscopic: The surgeon makes little incisions in the abdomen and inserts a camera and long surgical tools into the abdomen and operates inside the belly from outside the belly by looking at everything blown up on a big screen.
3. Robotic: Just like laparoscopic surgery except the surgeon sits at a console on the other side of the room and controls a robot attached to the camera and surgical instruments from afar. This technique is great for gynecologic surgery because it allows more angles of movement than laparoscopy.
4. Vaginal: The classic approach. A gynecologic surgeon can access the uterus, tubes, and ovaries from through the vagina. The patient doesn’t have any scars on her belly at the end and recovery is easier than the abdominal approach.
Reading this list, it’s easy to see why a vaginal approach is great for patients. However, there is one major downside: It is really hard to see! Medical students and interns are tasked with holding retractors at awkward angles to try to create a clear surgical area. Some surgeons wear lights on their heads or buy retractors with lights attached but usually only one surgeon can see anything at a time. It is no easy task to create space and light to see in a vaginal surgery.
In come Dr. Taylor and Dr. Myers. They saw their friends using a new device called the VITOM HD (video telescopic operating microscope) for procedures where gynecologists need to magnify the cervix. They asked themselves, what happens if we try to use the VITOM for operations? They attached the VITOM to the operating table about a foot and a half from the vagina. The surgeon could still look over the device and see the vagina.
The good doctors tried three different operations with this set up.
1. Vaginal hysterectomy and salpingectomy- the surgeon removes the uterus and tubes and leaves the ovaries.
2. Midurethral sling procedure- the surgeon attaches some extra support to help with urinary incontinence.
3. Release of a scar in the vagina- the surgeon cuts out the scar from a prior surgery to provide relief from discomfort from the scar.
Dr. Taylor and Dr. Myers had no complications. They could sit or stand, whichever was more comfortable. Best of all, the whole surgical team could view the surgery on the screen. The team did not have to change the patient’s position or the standard method for draping her in sterile sheets.
All in all, this new application of the VITOM system has a lot of promise for making vaginal surgeries easier and enabling the whole team to participate in and help with the surgery.